We will enhance the skill of rural health professionals in the utilization of point of care (POC) ultrasound. We will develop an approach that employs distributed education to provide on-site training, formative assessment and competence testing. The rationale for this research is that distributed education on-site facilitates rural providers' access to training by reducing financial and logistical hurdles and by enabling continuity of care to their patients. Distributed education enables deliberate practice over a period of weeks, which may yield better skill acquisition and retention than current condensed 1-2 day continuing medical education courses. By facilitating training of rural health care providers in POC ultrasound, the proposed research advances rural health care, which has always faced challenges in providing effective service due to a scarcity of local medical resources and distance between patients, physicians, and health care facilities. The first training modules will focus on cardiac and obstetric ultrasound, which were most frequently requested when we surveyed the 5-state WWAMI region (Washington, Wyoming, Alaska, Idaho, and Montana). To achieve these goals we will modify a simulator that we developed and validated for training cardiology fellows under other funding. Our Specific Aims are: #1: To develop a simulator-based distributed education course to provide rural health care providers with training and formative assessment of skill in POC cardiac and obstetric ultrasound. A method will be developed to enable remote mentoring of each trainee during initial scanning of normal volunteers. #2: To assess the educational validity of the distributed education course by measuring the transference of skill from simulator to live subjects, and to measure retention of skill. #3: To assess trainee satisfaction with distributed education. The HEALTH CARE BENEFIT of this research is enhancement of the safe and effective utilization of POC ultrasound through simulator-based distributed education. The deliverable is a distributed education module that is validated for training efficacy, competency testing, transference to live subject scanning, and remote learning. The method of distributed education that is developed and validated under the present proposal will be applicable to future applications for POC ultrasound such as procedural guidance.